Association of neighborhood socioeconomic deprivation with long term postoperative outcomes following cervical spinal fusion in a medicare-insured patient population
Medical Student Stanford Medicine Stanford, CA, US
Introduction: Cervical spine disease is associated with significant socioeconomic burden and the rate of cervical spinal fusion surgery has increased substantially in the past 2 decades. Several studies have examined the influence of socioeconomic status and short term outcomes of cervical fusion. However, few studies have examined the association between living in socioeconomic disadvantaged neighborhoods and long term outcomes of cervical fusion surgery. Studies have shown that 1 in 5 patients who underwent cervical fusion experience long term all-cause morbidity. Utilizing the area deprivation index (ADI), we aimed to determine the relationship between living in a socioeconomic disadvantaged neighborhood and postoperative outcomes following cervical spinal fusion in a medicare-insured patient population.
Methods: Adult patients undergoing first time inpatient cervical spinal fusion surgeries from 2006 to 2018 were identified from the Medicare 20% sample dataset. ADI were determined based on the patient’s zip code. Patients were segmented based on their ADI, with the bottom 85% composed of one segment and then the top 15% split into three groups of 5%. Regression analysis was performed for several surgical outcomes variables including length of stay, length of intensive care stay, 1 year complication, 1 year readmission, and 1 year mortality.
Results: A total of 80,287 patients underwent cervical spinal fusion during the study period. The average age of our cohort was 66±11 years and a majority were female (52.6%). Patients in the highest ADI segment were associated with increased length of stay (Coeff. 0.57, 95% CI 0.41-0.73), increased length of ICU stay (Coeff. 0.36, 95% CI 0.25-0.48) and increased odds of having 1 year complications (OR 1.19, 95% CI 1.1-1.29), 1 year readmission (OR 1.08, 95% CI 1.01-1.15), and 1 year mortality (OR 1.38, 95% CI 1.16-1.64).
Conclusion : Medicare patients from socioeconomic disadvantaged neighborhoods have worse long term postoperative outcomes following cervical spinal fusion. Future studies are needed to understand how to reduce the long term morbidity of patients who live in socioeconomic disadvantaged neighborhoods.